How to prevent CMV infection
What are the prophylactic strategies for CMV infection?
There are two strategies for CMV prevention; antiviral prophylaxis and preemptive monitoring/therapy. Antiviral prophylaxis means giving valganciclovir without any evidence of CMV infection or viremia. Preemptive monitoring/therapy means reserving antiviral therapy for patients who develop CMV viremia. Preemptive monitoring is associated with lower drug costs and adverse toxicities. However, there are increased laboratory surveillance and logistical labor. Antiviral prophylaxis, on the other hand, is more expensive and puts patients at risk for drug toxicity but is associated with decreased reactivation of other herpesvirus, lower rates of opportunistic infections, and allograft loss. The drug of choice for prophylaxis is valganciclovir. The duration of CMV prophylaxis depends on the CMV serology of the donor and recipient. D+/R- prophylaxis lasts 6 months, and all others last 3 months.